Comments for PHIL 471/871 Philosophy of Medicinehttps://philmed2011.wordpress.com
Instructor: Sergio SismondoSun, 28 Apr 2013 21:58:07 +0000hourly1http://wordpress.com/Comment on Prozac & Sarafe- Identical but different by Prozac Time | Life On My Gay Islandhttps://philmed2011.wordpress.com/2013/04/01/prozac-sarafe-identical-but-different/#comment-36
Sun, 28 Apr 2013 21:58:07 +0000http://philmed2011.wordpress.com/?p=1178#comment-36[…] Prozac & Sarafe- Identical but different […]
]]>Comment on What Constitutes ‘Genuine’ Consent? by shitangshuroyhttps://philmed2011.wordpress.com/2013/03/25/what-constitutes-genuine-consent/#comment-34
Tue, 26 Mar 2013 11:32:24 +0000http://philmed2011.wordpress.com/?p=1134#comment-34Your comment (and several other comments on the meaning of “informed consent”) raises an interesting question for me… which is more important: That one be informed when they give consent? Or that one have a reasonable opportunity to be informed (such as access to all relevant information in a clear fashion), whether they choose to use that opportunity or not? Let us assume the people in question also have the capacity for consent (e.g. they are literate).

I will posit, perhaps controversially, that it is the latter which matters. Why? Let’s extend the discussion passed clinical trials: When I got an “Optimum Card” from Shopper’s, I frankly did not read the “Terms & Conditions”… Later, I find out that the card is used to monitor my shopping habits at Shopper’s. This was probably mentioned in the consent forms, but lazy me, I did not read it. So, does Shopper’s have a right to continue to monitor my shopping habits? From their point of view, they cannot be blamed for my not reading the information: they had the info on a sheet and numbers to call if I did not understand something. Indeed, even if I did not read all the “Optimum Card” info, I may still have been “informed” in another way… by not reading the info carefully, I knowingly exposed myself to risks… at the time of signing, I knew Shopper’s could use me in a way I might disagree with (like invading the privacy of my consumption), but- attracted by reward points and lacking time- I did not take the opportunity to inform myself of these risks. I am at fault here.

]]>Comment on Further Ethical Issues in R&D by shitangshuroyhttps://philmed2011.wordpress.com/2013/03/18/further-ethical-issues-in-rd/#comment-33
Tue, 19 Mar 2013 06:15:03 +0000http://philmed2011.wordpress.com/?p=1094#comment-33Petryna’s analysis/ critique of Pharma’s preference for treatment-naive patients, which many bloggers have commented on, almost consistently in agreement with her, is problematic.

Three accounts one might give for Pharm’s preference to treatment-naive patients in clinical trials:
1- Petryna’s Version: Pharma wants to get more statistically significant results
2- A More Charitable Version: Pharma researchers want to control variables; an important variable is other medications a patient is taking; these variables cannot be controlled in patients which are taking many other medications, but can be controlled with treatment-naive patients
3- My own version: Both 1 & 2 matter to Pharma, but 2 is the more important reason

Explaining 2:
Imagine you have 3 possible sets of populations:
Set 1: 10,000 people are each taking at least 3 of the following drugs: A, B, C, D, E, F, G, H, I or J
Set 2: 10,000 people are taking no drugs
Set 3: 10,000 people taking exactly drugs A, B & C

If you want to control your “other drugs taken variable” (ODTV), which population set is desirable?
Set 1: This is representative of Western patients. It is not desirable, as there is a large range of drug regiments any given patient will be on, and it will not be possible to control the ODTV
Set 2: This is representative of Treatment-Naive Patients. ODTV is reasonably controlled.
Set 3: ODTV is controlled. However, there is hardly any such population in existence.

Conclusion: The scientific value of “treatment-naive” patients comes from the fact that the ODTV can be controlled in those populations. It is harder to get similarly useful and consistent data from Western patients, as there are too many variables that one cannot control.

]]>Comment on Publication bias by 14 to 40 percent of medical research are false positives (Yet Another Calculation) | Alea Deumhttps://philmed2011.wordpress.com/2013/02/25/publication-bias/#comment-32
Mon, 11 Mar 2013 01:16:15 +0000http://philmed2011.wordpress.com/?p=934#comment-32[…] Publication bias (philmed2011.wordpress.com) […]
]]>Comment on Should Pharmaceutical Advertising Be Banned by shitangshuroyhttps://philmed2011.wordpress.com/2013/03/04/should-pharmaceutical-advertising-be-banned/#comment-31
Tue, 05 Mar 2013 11:12:39 +0000http://philmed2011.wordpress.com/?p=991#comment-31I think cmclaren hints at an important issue which I hope will be discussed in class and which (I think) was not addressed by Dumit: Namely, what is it about pharmaceutical advertising that makes it distinct from other kinds of advertising? Why do we think certain pharma advertising practices- such as the creation of demand through making people want things they may not in fact need- are problematic, when such practices are employed by companies everyday? Is it the possibility of harm, as the blog entry suggested? Is it that being manipulated about one’s health is somehow worse than being manipulated about desires for other products or services? Is it that the product pharma is advocating is somehow bad (which seems unlikely)? If we want to hold pharma advertising to a different standard from other advertising, we need to justify why.

I do not pretend to know the answers to these questions, but let me give an example of desire manipulation in other kinds of advertising. Consider this ad for Everest College, which I suspect anyone with a TV has likely viewed before: http://www.youtube.com/watch?v=3bbFmZIdlBw .

Here, the ad is quite clearly suggesting that many people are dissatisfied with their lives but are simply too lazy to do anything about it, when most people will likely be content prior to viewing the ad. Clearly, the ad is trying to make people desire an education when this thought may not have been prevalent on the viewer’s minds (and all for the nominal cost of $30,000 :). If someone, influenced by this advertising, starts to feel dissatisfied with their lives and acts to enroll in Everest college to alleviate their career worries, do we say this advertisement has crossed some “moral line” of acceptable advertising? When pharmaceutical companies make people dissatisfied with their health and influence them to purchase medication to alleviate their health worries, should we judge them to a different standard than we did Everest College?

Again, I emphasize that I have no answers… only many questions. On the surface, there seems to be a double-standard in regards to our expectations for pharmaceutical advertising, but I suspect the applicability of different standards to Pharma can somehow be justified.

]]>Comment on Week 8 Summary: Ecks, Applbaum, and Dumit by jlandry9https://philmed2011.wordpress.com/2013/03/02/week-8-summary-ecks-applbaum-and-dumit/#comment-30
Tue, 05 Mar 2013 01:00:37 +0000http://philmed2011.wordpress.com/?p=975#comment-30Nicely done!
]]>Comment on When the Evaluated Pay their Evaluators… by shitangshuroyhttps://philmed2011.wordpress.com/2013/02/25/when-the-evaluated-pay-their-evaluators/#comment-29
Tue, 26 Feb 2013 02:45:50 +0000http://philmed2011.wordpress.com/?p=942#comment-29In case folks were interested, you can read about the over-rating of bonds by ratings agencies in Marc Joffe’s recent article in The Guardian, entitled “Moody’s, S&P and other Credit Rating Agencies Deserve a Failing Grade” (found at: http://www.guardian.co.uk/commentisfree/2013/feb/25/moodys-sp-credit-rating-agencies-need-reform). This phenomenon is also widely discussed in in many economics publications. A documentary which I think discusses bond ratings, among other recession-related issues, is CBC’s “Meltdown” (http://www.youtube.com/watch?v=ZWU65Zbka4E; an excellent documentary for those interested in the recent recession). There is also a useful article on “Bond Rating Agencies” from the ever-reliable Wikipedia.
]]>Comment on Deeper Problems to Pharmaceutical Sales by shitangshuroyhttps://philmed2011.wordpress.com/2013/02/08/deeper-problems-to-pharmaceutical-sales/#comment-28
Tue, 12 Feb 2013 15:32:26 +0000http://philmed2011.wordpress.com/?p=871#comment-28Completely agree that asking how some drugs that are (putatively) “toxic” get approved in the first place is the right question to ask. I was just checking the FDA (US Food and Drug Administration) website, and here’s what they say about their drug approval process:

“Drug companies seeking to sell a drug in the United States must first test it. The company then sends CDER (the FDA’s specific branch for drug investigations) the evidence from these tests to prove the drug is safe and effective for its intended use. A team of CDER physicians, statisticians, chemists, pharmacologists, and other scientists reviews the company’s data and proposed labeling. If this independent and unbiased review establishes that a drug’s health benefits outweigh its known risks, the drug is approved for sale. The center doesn’t actually test drugs itself, although it does conduct limited research in the areas of drug quality, safety, and effectiveness standards” (FDA website; see link below).

From this, it sound like most of the data used to approve pharmaceutical drugs comes from the drug companies themselves! Admittedly, money might be a factor since drug testing is probably very expensive, but I for one was always under the impression that the FDA`s reputed “independent and unbiased review” meant they did their OWN tests and got their OWN data, with the drug companies’ data basically thrown out of the window.

]]>Comment on The Pursuit of Health: It Makes me Sick by 8mv6https://philmed2011.wordpress.com/2013/01/28/the-pursuit-of-health-it-makes-me-sick/#comment-27
Tue, 29 Jan 2013 01:56:50 +0000http://philmed2011.wordpress.com/?p=758#comment-27I totally agree! I also have a serious worry that people are spending so much time trying to be healthy and extend their lives, that they are forgetting to live at all. Pharmaceutical companies also capitalize off of that as well, I think.
]]>Comment on Fleck (long summary) by shitangshuroyhttps://philmed2011.wordpress.com/2013/01/20/fleck-long-summary/#comment-26
Tue, 22 Jan 2013 11:01:50 +0000http://philmed2011.wordpress.com/?p=677#comment-26Firstly, awesome summary, Krista!

Secondly, there are a couple questions which I hope come out in the class discussions. Firstly, I am not sure if others had the same experience, but I found myself thinking back to the first week’s readings when looking at Fleck, specifically, asking myself: Would “Syphilis” be a human kind or a natural kind for Hacking, and is there a kind of “looping effect” that is identifiable with the eventual association of Syphillis with Spirochaeta pallida? And, secondly, after Simon gives us more terminology (since we clearly need to confused with even more concepts! :)— realism, anti-realism and his constructive realism— I wonder how well, if at all, these later distinctions might map onto Hacking’s human/ natural kind dichotomy?

In other words, while these authors try to understand how certain medical concepts arise, one can also step back and notice those same authors are introducing concepts about medical concepts, and at times using disparate words to describe similar ideas. It is thus also intriguing to ask how concepts about medical concepts, in particular of our weekly readings’ authors, arise and relate to each other.